Since arriving on the scene about five years ago, the Soska sisters—aka The Twisted Twins—have become something of a cult of personality, and American Mary reveals why. Even if their sophomore effort isn’t a complete success, it’s appreciably interesting; there’s a distinctiveness to its gruesome preoccupations, its black humor, and its glancing blows at sexual politics. Granted, they don’t all gel together, but the film remains compelling as hell thanks in large part to star Katharine Isabelle, who doesn’t waste her long-deserved chance back in the spotlight.

Isabelle is Mary Mason, a med student studying to be a surgeon who finds herself struggling with a mountain of debt (higher education will do this to you, and it is a cruel, bloodsucking mistress). Looking to get the collection agencies off her back, she applies at a seedy massage parlor, where the shady proprietor (Antonio Cupo) happens to find himself in quite a predicament: some of his goons have severely injured a man, and he’d rather not let the poor guy to die on his watch. Thinking quickly on his feet, he enlists Mary’s surgical skills and pays her $5,000; she reluctantly agrees, and the sleazy club owner’s connections open the door to an underground body modification community that begins to seek Mary’s talents.

If the Soskas were content to narrow their focus to Mary’s increasingly disturbing trip down this sordid rabbit hole, American Mary would be a complete triumph. There’s enough compelling material here to carry an entire film to be sure, as it’s full of assorted oddballs that cause Mary to lose herself in their fascinating world—it’s sort of like an updated version of Freaks in its sympathetic portrait of society’s misunderstood outcasts. One of Mary’s primary contacts is Beatress (Tristan Risk), a stripper who has transformed herself into a nightmarish version of Betty Boop. As Mary’s entry point to this world, she introduces her to other clients, including a woman who wants any trace of her sexuality to be removed so that she can resemble a doll. (The Soskas themselves also appear as a pair of German twins looking to “deepen their connection” with each other via amputated limbs and implanted devil horns.)

But the problem is that the film seemingly has very little to say beyond its reverence for this scene, so the Soskas conjure up various detours and subplots to compensate. Chief among them is the revelation that Mary’s professor (David Lovgren) is a complete scumbag running an illicit sex ring with other faculty; after inviting Mary to one of their parties, she witnesses their brutality first-hand and vows to take her revenge. Suddenly, American Mary is transformed into a rape-revenge film of the oddest sort, as the latter part of that dynamic is prolonged in agonizing fashion for Mary’s victim, who becomes a body mod guinea pig. His disappearance naturally lands Mary in the crosshairs of a local detective’s investigation, and this is not to mention the bizarre relationship that develops between her and the club owner.

With the film skimming around so many subplots, it never quite finds the time to do justice to any of them, but Isabelle makes for a hell of a center to stabilize the proceedings. Her immense talents as an actress have never been more obvious than they are here: Mary’s journey towards becoming a sociopath is imminently fascinating. You sense she has that capability early on, as her introduction has her stitching up a bird (thus putting her on the path towards Bates Motel); and yet, when she first encounters the body mod underworld, she reacts as any normal person might, with a mixture of intrigue, horror, and deadpan incredulity. As she burrows deeper, she likewise becomes more insular and introverted; her confidence in her work might become more obvious, but, deep down, you sense she’s always going to be the sort of girl who can never quite fix herself. Mary is driven by insecurity and a need for approval, no matter what sort of hardened exterior she puts forth, all of which is communicated masterfully via Isabelle’s performance.

As she burrows deeper, she likewise becomes more insular and introverted; her confidence in her work might become more obvious, but, deep down, you sense she’s always going to be the sort of girl who can never quite fix herself. Mary is driven by insecurity and a need for approval, no matter what sort of hardened exterior she puts forth, all of which is communicated masterfully via Isabelle’s performance. That American Mary never coheres thematically is disappointing, but its haunting final image casts the film in sharp relief, at least—if nothing else, the film has a keen sense of character, even if it’s not quite sure what to do with most of the stuff surrounding Mary.

If nothing else, though, the proceedings are skillfully captured. While the end credits dedicate the film to Eli Roth, the influence of Tom Six’s original Human Centipede seems just as obvious. Like that film, American Mary just feels uncomfortable despite not displaying very much on-screen violence. Usually, we’re privy to Mary’s preparation for her procedures and maybe some choice bits during the surgeries, but they’re mostly elided over. Still, the film is quite squirm-inducing, its events rendered all the more off-putting by the incongruously refined photography. In this respect, the film couldn’t be more different from their gritty, grungy debut, as that aesthetic is swapped for something more restrained and classical, even as viewers follow Mary down a grimy, disturbing path.

Managing to create such uneasiness without leaning on overt schlock is quite a skill and proves that the Soskas have little interest in retreading familiar ground. About the only thing American Mary and Dead Hooker in a Trunk share is a complete commitment to both their characters and premises; both could have been reduced to ridiculous jokes in lesser hands, but the Twisted Twins aren’t interested in such glibness. I’m almost wary that their next project involves them doing what feels like studio grunt work on See No Evil 2, but if anyone can make that an interesting proposition, it’s these two. Buy it!